BACKGROUND: Osteonecrosis of the femoral head generally presents with collapse of the femoral head. A small subset of patients with osteonecrosis of the femoral head, however, have been described in various case reports as presenting with subcapital femoral neck fracture instead. METHODS: The three cases presented were gathered retrospectively from the National Joint Registry in Malawi. RESULTS: We present three case reports of patients with HIV who suffered atraumatic subcapital femoral neck fractures in the setting of osteonecrosis of the femoral head. DISCUSSION: Patients with subcapital femoral neck fractures and osteonecrosis of the femoral head in the setting of HIV represent a unique population with diagnostic and management dilemmas that require careful consideration.